Knowledge and attitudes of healthcare professionals in the Šibenik-Knin and Zadar Counties regarding care for patients at the end of life

Palijativna skrb predstavlja sveobuhvatan način pružanja potrebne skrbi pacijentima koji imaju neizlječivu bolest i/ili su na kraju svoga života. U istraživanju na području Šibenskokninske i Zadarske županije sudjelovalo je 112 zdravstvenih djelatnika (84,8% medicinskih sestre, 15,2% drugi zdravstveni radnici). Korišten je anketni upitnik sastavljen od nekoliko validiranih upitnika. Upitnikom se ispitivala razina znanja o palijativnoj skrbi, stavovi o skrbi na kraju života te stavovi o eutanaziji. Za prikaz rezultata korištene su deskriptivne metode, a razlike među skupinama testirane su Mann Whitney testom. Rezultati pokazuju dobro znanje zdravstvenih djelatnika o palijativnoj skrbi, pozitivan stav o skrbi za pacijente na kraju života te pretežno negativan stav o provođenju eutanazije. Međutim, zdravstveni djelatnici imaju manje spoznaja o trenutku započinjanja palijativne skrbi u pacijenata u kojih se dijagnosticira neizlječiva bolest te pružanju palijativne skrbi svakom pacijentu s malignom bolesti (Me=2,0 (Q1=1,0; Q3=3,0); za oboje). Medicinske sestre pokazale su nešto višu razinu znanja (Me=3,67 (Q1=3,53; Q3=4,0)) o palijativnoj skrbi u odnosu na druge zdravstvene profesije (Me=3,43 (Q1=3,53; Q3=4,0), (p=0,01). Skoro trećina ispitanika (27,6%) bi se osjećala nelagodno tijekom razgovora s osobom na kraju života, dok je 23,2% ispitanika iskazuje neodlučnost. Nije pronađena statistički značajna razlika u stupnju pozitivnog (p=0,50) i negativnog stava (p=0,14) o skrbi na kraju života između medicinskih sestra i ostalih zdravstvenih profesija. Eutanaziju ne podržavaju ni medicinske sestre (Me=1,8 (Q1=1,3; Q3=2,7)), ni ostale profesije (Me=1,9 (Q1=1,7; Q3=2,7)), a razlike u jačini tog stava među profesijama nisu pronađene (p=0,31). Iako je razina znanja pozitivno usmjerena ovo istraživanje potvrđuje potrebu za dodatnim povećanjem razine znanja zdravstvenih djelatnika, posebice o trenutku započinjanja palijativne skrbi i komunikaciji s pacijentom na kraju života. Negativan stav prema eutanaziji i njezinim oblicima može se objasniti doprinosom različitih osobnih, profesionalnih i kulturoloških čimbenika. Studija ukazuje na potrebu za novim istraživanjima posebice na području komunikacije, edukacije zdravstvenih djelatnika i etičkih pitanja. Uzimajući u obzir veći porast oboljelih od neizlječivih bolesti ovi rezultati mogu doprinijeti i većoj senzibilizaciji javnosti za potrebe pacijenata s potrebama za palijativnom skrbi.Palliative care is a comprehensive form of care for patients who are suffering from an incurable illness and/or are at the end of life. 112 healthcare workers (84,8% nurses, 15,2% other healthcare workers) participated in the survey in Šibenik-Knin and Zadar counties. A survey questionnaire was used, which consisted of several validated questionnaires. The questionnaire examined the level of knowledge about palliative care, attitudes toward end-oflife care, and attitudes toward euthanasia. Descriptive methods were used to present the results, and differences between groups were tested using the Mann-Whitney test. The results show that health professionals are well aware of palliative care, have positive attitudes toward end-of-life care, and are overwhelmingly opposed to performing euthanasia. However, health professionals have less significant knowledge about the timing of initiation of palliative care for patients diagnosed with a terminal illness and the provision of palliative care for each patient with a malignant disease (Me=2.0 (Q1=1.0; Q3=3.0); for both). Nurses had a slightly higher level of knowledge (Me=3.67 (Q1=3.53; Q3=4.0)) about palliative care than other health professionals (Me=3.43 (Q1=3.53; Q3=4.0), (p=0.01). Almost one-third of respondents (27.6%) would feel uncomfortable talking to a person at the end of life, while 23.2% expressed indecision. No statistically significant difference was found in the degree of positive (p=0.50) and negative attitudes (p=0.14) toward end-of-life care between nurses and other health professionals. Euthanasia was not endorsed by nurses (Me=1.8 (Q1=1.3; Q3=2.7)) or other professions (Me=1.9 (Q1=1.7; Q3=2.7)), and no differences in the strength of this attitude were found between professions (p=0.31). Although the level of knowledge is positively oriented, this study confirms the need to further increase the level of knowledge of health professionals, especially regarding the timing of the start of palliative care and communication with the patient at the end of life. Negative attitudes toward euthanasia and its forms can be explained by the contribution of various personal, professional, and cultural factors. The study points to the need for new research, particularly in the areas of communication, education of health professionals, and ethical issues. Given the increasing number of patients with terminal illnesses, these findings may contribute to greater public awareness of the needs of palliative care patients